Some standard content:
ICS13.100
National Occupational Health Standard of the People's Republic of China GBZ106-2002
Diagnostic criteria for radiation skin diseases
Diagnostic criteria for radiation skin diseases2002-04-08
Issued by the Ministry of Health of the People's Republic of China
Implemented on 2002-06-01
3.1.1, 3.1.2, 3.2.1, 3.2.2, 3.3 of this standard are mandatory, and the rest are recommended. GBZ106-2002
This standard is specially formulated in accordance with the Law of the People's Republic of China on the Prevention and Control of Occupational Diseases. In case of any inconsistency between the original standard GB8282-2000 and this standard, this standard shall prevail.
Since the release of GB8282-2000 "Diagnostic Criteria and Treatment Principles for Radiation Skin Diseases", new clinical experience has been accumulated in the process of practice, and new progress has been made in scientific research, so it is necessary to revise it. In addition to changing the clinical grading of acute skin damage from three to four degrees in this revision, there are also many modifications and additions to the reference dose of acute skin damage, the annual dose of chronic skin damage, and the characteristics of skin damage caused by beta rays.
Appendix A of this standard is an informative appendix
This standard is proposed and managed by the Ministry of Health of the People's Republic of China. The drafting units of this standard are: Institute of Radiation Medicine, Shanghai Medical University, China Institute of Radiation Protection, and Affiliated Hospital of the Academy of Military Medical Sciences. The main drafters of this standard are: Weng Zhigen, Liu Yanling, Yang Zhixiang, and Zhang Hongshou. This standard is interpreted by the Ministry of Health of the People's Republic of China. 2
1 Scope
Diagnostic criteria for radiation skin diseases
This standard specifies the diagnostic criteria and treatment principles for acute and chronic skin damage caused by ionizing radiation. GBZ106-2002
This standard applies to radioactive workers with skin damage caused by ionizing radiation. Non-occupational exposed personnel can also refer to this standard for diagnosis and treatment.
2 Terms and Definitions
The following terms and definitions apply to this standard. 2.1 Acute radiation injury of skin Acute radiation dermatitis and radiation skin ulcers caused by a single or multiple high-dose (x, gamma and beta rays, etc.) external irradiation of a part of the body within a short period of time (several days).
2.2 Chronic radiation injury of skin Chronic radiation dermatitis and chronic radiation skin ulcers caused by acute radiation injury of skin or by long-term exposure to low-dose radiation (occupational or iatrogenic).
2.3 Skin cancer induced by radiation Skin cancer that occurs on the basis of radiation damage to the skin caused by ionizing radiation. 3 Diagnosis and treatment
3.1 Diagnosis and treatment of acute radiation skin injury 3.1.1 Diagnostic criteria
3.1.1.1 A diagnosis is made through comprehensive analysis based on the beneficiary’s occupational history, skin exposure history, exposure dose provided by statutory local dose testing, on-site personal dose survey and clinical manifestations. Table 1 Diagnostic criteria for the classification of acute radiation skin injury Grading
Initial reaction period
Erythema, burning sensation
False healing period
2~6 weeks
1~3 weeks
Obvious clinical symptoms period
Follicular papules, temporary hair removal
Hair removal, erythema
Secondary erythema, blisters
Erythema, numbness, itching, edema, tingling for a few hours to 10 days,, secondary erythema, blisters, necrosis, ulcer Reference dose, Gy
≥3~
≥10~
≥20~
3.1.1.2 The main clinical manifestations and prognosis after skin exposure vary depending on the type of radiation, irradiation dose, dose rate, radiation energy, irradiated site, irradiated area and physical condition. Make a graded diagnosis according to Table 1: 3.1.1.3 The final diagnosis should be based on the skin manifestations during the period of obvious clinical symptoms, and refer to the radiation dose value. 3.1.2 Treatment principles
Immediately get away from the radiation source or prevent the irradiated skin from being irradiated or stimulated again. If radionuclides are suspected to be contaminated on the skin, it should be washed and decontaminated in time. For life-threatening injuries (such as shock, trauma and heavy bleeding), emergency treatment should be given first. 3.1.3 Systemic treatment
When the skin injury area is large and deep, whether or not combined with whole body external irradiation, bed rest should be given and systemic treatment should be given. 3.1.3.1 Strengthen nutrition, give a high-protein diet rich in vitamins and trace elements. 3.1.3.2 Strengthen anti-infection measures and use effective antibiotics. 3.1.3.3
Give vitamins, such as vitamins C, E, A and B3.1.3.4: Give sedatives and analgesics. When the pain is severe, pethidine can be used, but addiction should be prevented. 3.1.3.5 Pay attention to water, electrolyte and acid-base balance, and transfuse fresh blood if necessary. 3
GBZ106-2002bZxz.net
3.1.3.6 According to the needs of the disease, various protease inhibitors, free radical scavengers and drugs that increase the body's immune function can be used, such as superoxide dismutase (SOD), alpha-2-macroglobulin (α2M), and immunoglobulin preparations. 3.1.3.7 If necessary, drugs that promote blood circulation and remove blood stasis and improve microcirculation can be used, such as compound danshen and low-molecular-weight dextran. 3.1.3.8 If combined with internal contamination, complexing agents should be used to promote excretion. 3.1.4 Local conservative treatment
3.1.4.11. Before blisters appear on the skin of grade II radiation skin damage or grade IIII radiation damage, pay attention to protecting the local skin. Antihistamines or corticosteroids can be used if necessary. 3.1.4.2 When blisters appear in grade III and IV radiation skin injuries, the blister fluid can be extracted under strict disinfection, and the wound surface can be wetted with Vesque solution and bandaged with pressure to prevent infection.
3.1.4.3 When the blister skin is contaminated with radionuclides, it should be cleaned first and then cut off. 3.1.4.4 For grade IV radiation skin injuries, blisters rupture to form superficial ulcers, and Vesque solution can be applied externally to prevent wound infection. If the wound surface is secondarily infected, sensitive antibiotics can be used for wet compresses based on the results of bacterial culture on the wound surface. Surgery should be performed in a timely manner after entering the recovery period. 3.1.5 Surgical treatment
3.1.5.1 Surgical treatment should be avoided as much as possible in the acute stage, because the lesion is still progressing at this time, and it is difficult to determine the scope of the lesion for surgery. If necessary, simple necrotic tissue resection and biological excipients and free skin graft coverage can be performed. Pay attention to protecting local function. Perform complete surgical treatment after the recovery period. 3.1.5.2 Grade IV radiation skin damage located in functional areas or ulcers with an area larger than 25 cm should be treated with early surgery. 3.2 Diagnosis and treatment of chronic radiation skin damage 3.2.1 Diagnostic criteria
3.2.1.1 The local skin is irradiated for a long time exceeding the dose limit, and the cumulative dose is generally greater than 15Gy (with personal dose records). After several years of exposure, chronic lesions appear in the skin and its appendages, which can also be caused by acute radiation skin damage. The diagnosis should be made through comprehensive analysis combined with health records and exclusion of other skin diseases.
3.2.1.2 Chronic radiation skin injury can be diagnosed according to Table 2: Table 2 Diagnostic criteria for the classification of chronic radiation skin injury Classification
Clinical manifestations (necessary conditions)
Skin pigmentation or loss, roughness, gray nails or vertical stripes of color on the nail skin, hyperkeratosis, cracking or atrophy and thinning, capillary dilation, thickening, deformation, necrosis and ulceration of nails, keratin protrusions, keratinization and fusion of fingertips, tendon contracture, joint deformity, dysfunction (any one of them is sufficient) 3.2.2 Treatment principles
For occupational radiation workers, patients with grade I chronic radiation skin injury should properly protect the local skin from trauma and excessive radiation, and be observed for a long time; those with grade I and II injuries should reduce radiation exposure or leave radiation work, and receive active treatment depending on the size and severity of the skin injury area; those with grade III injuries should leave radiation work and receive timely local and systemic treatment. For ulcers that do not heal for a long time or severe skin tissue hyperplasia or atrophic lesions, surgical treatment should be performed as soon as possible. 3.2.3 Local conservative treatment
3.2.3.1 Grade I injuries do not require special treatment. Moisturizing creams and ointments can be used to protect the skin. 3.2.3.2 Grade II injuries have keratin hyperplasia, desquamation, and cracks. Use creams or ointments containing urea drugs to soften the keratinized tissue or use less irritating creams to protect the skin.
3.2.3.3. In the early stage of II-degree injury or with small ulcer, in the short term, Visk solution or antibiotic creams and ointments containing superoxide dismutase (SOD), epidermal growth factor (EGF), and Zn can be used locally, and alpha-2-macroglobulin preparations can be used in combination to accelerate wound healing. If the wound is sometimes better and sometimes worse, surgical treatment should be performed in time. 3.2.4 Indications for surgical treatment
For wounds with severe radiation-induced skin damage, a thorough local extended excision surgery should be performed in a timely manner, and then skin grafts or flaps should be used for wound repair. The indications for surgical treatment are as follows4
3.2.4.1 When local skin lesions are suspected of malignant transformation; 3.2.4.2
Those with severe keratinization, hyperplasia, atrophy, chapped skin, wart-like protrusions or ulcers: Those with skin scar deformities that hinder limb function: Those with long-term unhealed ulcers, which are large and deep, with fibrosis of surrounding tissues and poor blood supply. 3.2.4.4
Diagnosis and treatment of radiation-induced skin cancer
3.3.1 Diagnostic criteria
Skin cancer must occur at the site of original radiation damage. Before the canceration, it manifests as radiation-induced hyperkeratosis or long-term radiation ulcers that do not heal. Any skin cancer that does not occur at the site of radiation-induced skin damage cannot be diagnosed as radiation-induced skin cancer. The cell type of radiation-induced skin cancer that occurs on the hands is mostly squamous cell carcinoma. Treatment principles
Radiation-induced skin cancer should be surgically removed as soon as possible. The local area of radiation-induced skin cancer should strictly avoid exposure to radiation, and radiation therapy is generally not suitable. When finger (limb) amputation is required to remove the tumor for radiation-induced skin cancer, it should be carefully considered. GBZ106-2002
GBZ106-2002
Appendix A
(Informative Appendix)
Instructions for the correct use of this standard
A1 The diagnosis of radiation skin damage is mainly based on the exposure history, exposure dose and gradually manifested skin manifestations that exceed the local dose limit, and fungal infection, flat warts, chronic eczema and other non-radioactive contact dermatitis should be excluded. After many years of clinical practice, the radiation dose reading that causes skin damage has been given more clearly, but due to different radiation energies and different exposure conditions, it is still difficult to give a correct universal threshold dose. The exposure dose thresholds that cause certain skin damage given in this standard are only reference values, and their clinical grading is still based mainly on clinical manifestations.
Simple radiation skin damage without systemic changes that can be diagnosed as radiation sickness cannot be diagnosed as radiation sickness. 6
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